Pressure ulcer dressing in community placement - Essay Example

Description Throughout my community placement practice, I have particularly dealt with pressure ulcers on a frequent basis than many other forms of injuries. Apparently I never thought that they could be a serious issue as they turned out and I had to perform extensive research and on them. In clinical practice, pressure ulcers or decubitus ulcers can be described as damage affecting skin and the tissues beneath (Miller, 2008) , as occasioned by three main factors. The contributing factors to pressure ulcers are; pressure, shear and friction. In all community placement encounters dealing with pressure ulcers, I have found out that the most useful way of identifying pressure ulcers is the skin discolouration. This class of ulcers ranged from skin discolouration in slight damages to broken skin with open wounds in extreme cases. I have found out also that the level of damage could be gauged in some instances on the state of the physical appearance of the skin, before assessing the underlying tissues damage (JBI, 2008, pp1). Research findings enabled me to apply better practices such as ensuring that the wounds remained moist unlike before where they were macerated and gave poor results. For healing of pressure wounds to occur, infections and sloughing were minimised by ensuring that the wound environment remained in a conducive. Temperature was to be maintained at an optimum and that the pH maintained was optimum for wound healingas noted by Baranoski and Ayello (2008) . The most important aspect of control for the wound management was the dressing. Feelings All along, I thought pressure ulcers could be handled like other wounds and injuries. In many instances, it took long to determine the correct approach to deal with these injuries, until I realised that special attention is needed in some specific issues presented by pressure ulcers. Initially, there was a problem in dealing with wound management. It was not until I realised that my wound management required having a different approach, especially for the type of injuries causing tissue damage. A comprehensive wound management demanded that I employ thorough assessment going deep into the wound history, location, characteristics and whether the recurrence of the wound is likely after treatment. Grading pressure ulcers on their severity and the condition of the patient assisted in formulating the best wound management, which finalises on the dressing mode (Allman et al, 2004, p53). As it turned out in almost all the cases, pressure ulcers occurred on body parts that have bony prominences and almost absent in other tissues. Consequently, the bones close to the skin cause the pressure exerted on the skin to damage the skin and to a large extent the underlying tissues. It was also evident that some groups of people were at a higher risk of exposure to pressure ulcers than others. This is on a measure of exposure to skin pressure that the individuals could not manage. Some of the people that I found out to be affected most include those; with a problem of movement resulting in difficulty to change their positions unless assisted, with difficulty in sensing pain, people undergoing surgery, very young or old people, people suffering from malnourishment (NICE, 2005, p14). People with a relatively higher predisposition factor to acquiring pressure ulcers can be identified using an assessment detailing on the probability of exposure. Asking questions from the patients revealing their state of exposure to some of the above mentioned situations assisted in establishing the severity and diagnosis. Assessing the severity of the ulcer is useful in planning for the intervention measure to implement, especially for the dressing of certain pressure ulcers. Evaluation The best dressing choice must always correspond to the assessment detail revealing the severity and the patient condition. This implies that a particular type of dressing could be a better choice for a certain patient and not another. For the damage that underlying tissues could be exposed to, pressure ulcers are usually dressed with dressing types that facilitate optimal wound healing. Generally, there are many dressing choices suitable for optimal wound healing which include; hydrocolloids, films, alginates, soft silicates among others (Bader, Bouten, & Colin, 2005). This is because basic dressing types do not allow moist conditions that the optimum healing needs. The underlying tissue damage is a factor that I realised needs to be approached with caution (Wells, 2007, p7). Before determining the best choice for dressing to use in pressure ulcers, I realised grading the damage was always very important. Classification of wounds has four grades such that grade I through IV reveal the severity and the influence that it has on the choice of dressing. Based on the cases that I have tackled, it is slightly difficult but manageable to classify pressure ulcers on physical and underlying tissue damages sustained by the patient. Grade I consists of slightest damage involving the discolouration of the skin and heat and swelling. It is characterised by an intact skin, despite there being the injury to underlying tissues. Grade II is composed of injuries with slight skin loss that may go only to the epidermis or dermis and may sometimes involve both. The skin is not necessarily intact and may appear as a blister or abrasion. For Grade III, there is a full skin loss going deep to the subcutaneous tissue and often touch underlying fascia. In the most severe class, Grade IV, there is extensive skin and tissue loss. A higher chance that bone and muscle damage are sustained is in patients qualified the case to be a grade IV pressure ulcer. In my optimised approach, I found out that carrying out debridement assisted in acceleration of healing of pressure ulcers to a considerably high confidence measure. The performance of debridement has always been in selected Grade II and IV cases of pressure ulcers. Debridement is the removal of necrotic tissue that is considerably affected. I realised even if there were chances of full recovery of the tissues, it was seemingly unpredictable as to the effect that the tissues had on the neighbouring tissues. It was also hard to predict the duration of time that a severely damaged region could take to complete recovery. Alternatively, when dressing pressure ulcers with extensive tissue damage, it was difficult to determine the affectivity of the dressing, unless the state of the tissues was determined. Analysis I particularly found that hydrocolloid dressings such as comfeel are more effective when used on incision sites of pressure ulcers and can stay for a while without changing, facilitating faster healing. They are however useful in Grade I and II pressure ulcer dressing and may particularly be effective in Grade III and IV. Where the wounds were infective, I found out that the hydrocolloid gave poor results and the dressing had to be repeated (Cherry et al, 2006, p112). Another dressing mode that I have found to be effective was the use of soft silicone contact layers (such as mepilex border). When pressure ulcers produce exudes, I have found out that soft silicone contact layers are suitable in a number of ways. The ease of usage alongside wound gels is a positive factor I have found in these layers. Alternatively, I have found high success in any grade pressure ulcer when using alginate dressings, making it the best choice particularly for ulcers that are prone to infections. Examples of alginate dressings are Sorbsan, Seasorb and Kaltostat (Alisan, Bergstrom & Richard, 2004). Since Grade III and IV pressure wounds have been tricky for many clinicians, I have found it a tricky business but not with the option of silver dressings that allow introduction antimicrobial elements to be used in dressing. An example of a silver dressing that I have successfully used is Acticaot. The longer duration of time that the dressing can be used for without changing enables minimisation of disturbance to the wound. A highly sensitive dressing technique for pressure ulcers that I have encountered is the hydrogel that has performed pretty well in ulcers requiring desloughing and debridement. Conclusion Apart from use of the above mentioned methods of dressing pressure ulcers, I have realised that other techniques such as use of negative pressure wound therapy could be useful in handling pressure ulcers. Application of debridement in cases of wounds that take long time to heal due to infections and necrosis of tissues could complement dressing affectivity (Ousey, 2005, p114. Patients with more severe pressure ulcers need specialised wound management and attention, such as those in grade III and IV, which predisposes them to risks of infection. Dressings creating optimal healing environment should be applied in patients suffering from pressure ulcers. Movements and change of position are very important in the healing of pressure ulcers that belong to grade III or IV. Action Plan In future, I will handle all pressure ulcers from an informed perspective that grading and dressing choice present. Wound management practices that are emerging at a promising rate could offer dressing solutions facilitating faster healing. Before determining the best choice for dressing to use in pressure ulcers, I realised grading the damage was always very important. Classification of wounds has four grades such that grade I through IV reveal the severity and the influence that it has on the choice of dressing. Based on the cases that I have tackled, it is slightly difficult but manageable to classify pressure ulcers on physical and underlying tissue damages sustained by the patient. References Alisan M., Bergstrom N. & Richard M. (2004) “Treatment Of Pressure Ulcers: Clinical Practice Guideline”. Clinical Practice Guideline. Vol 15 Issue 95, Part 652 of AHCPR DIANE Publishing. Allman, R. M., Bennett M. A., & Bergstrom N. (2004) Treatment of pressure ulcers: clinical practice guidelines. Rockview, ML: DIANE Publishing Bader D., Bouten C., & Colin D. (2005) Pressure ulcer research: current and future perspectives. (Oomens Ed.) シュプリンガー・ジャパン株式会社. Baranoski S. & Ayello E. (2008) Wound care essentials: practice principles. Lippincott Williams & Wilkins. Cherry, G., Clark, M., & Romanelli, M. (2006) Science and practice of pressure ulcer management. Ghent, Belgium: Birkhäuser Publishers Miller C. (2008) Nursing for wellness in older adults (5th ed.). Lippincott Williams & Wilkins. National Institute for Health and Clinical Excellence (NICE) (2005) “Pressure Ulcers- Prevention and Treatment.” < http://www.nice.org.uk/nicemedia/pdf/CG029publicinfo.pdf> Ousey, K., (2005) Pressure area care. Victoria, Australia: Wiley-Blackwell The Joanna Briggs Institute (JBI) (2008) “Pressure Ulcers- Management of Pressure Related Tissue Damage.” Best Practice, vol.12 no.3 pp1-4 http://www.joannabriggs.edu.au/pdf/BP_Book_Vol12_3.pdf Wells, J. (2007) “Dressing for Managing Pressure Ulcer.” http://www.rch.org.au/emplibrary/rchcpg/Dressing_for_Managing_Pressure_Ulcer.pdf Read More